The effect of oral magnesium supplementation on insulin sensitivity and electrolyte balance in essential hypertension

Aim: This study aimed to investigate the effect of oral magnesium supplementation on ambulatory blood pressure (ABPM), insulin sensitivity (IS) and electrolyte balance in patients with mild essential hypertension. Methods: Blood pressure (BP) was assessed using ambulatory BP monitoring (ABPM). Insulin Sensitivity was estimated with Insulin Sensitivity indices derived from in Oral Glucose Tolerance Test (OGTT) and there were also laborious methods for serum and intracellular ions determination, serum lipids, fasting glucose and insulin levels and other standard biochemical parameter. Conclusion: This study presented some new and important evidence concerning the effects of magnesium and confirmed some findings with regard its impact on a group of patients with hypertension. In summary, the following were observed in the patients of our study: 1) a significant improvement in insulin sensitivity, 2) a significant decrease in SBP and DBP levels, 3) a significant decrease in total serum cholesterol and triglycerides and increase of HDL cholesterol, 4) a significant increase in icMg and icK levels and a decrease in icCa and icNa, 5) a decrease in both glucose AUC and insulin AUC.Σκοπός αυτής της μελέτης ήταν να ερευνηθεί: α) η επίδραση της χορήγησης μαγνησίου (Mg) σε υπερτασικούς ασθενείς πάνω στην ΑΠ., β) να ερευνηθούν οι μεταβολές των ενδοκυττάριων ιόντων K⁺, Na⁺, Ca⁺⁺, Mg⁺⁺ μετά την χορήγηση Mg και γ) να διαπιστωθεί αν οι μεταβολές των ενδοκυττάριων ιόντων επηρεάζουν την ινσουλινοευαισθησία. Μέθοδοι: 34 ασθενείς με ήπια ανεπίπλευτη ΑΥ πήραν μέρος στην μελέτη. Από αυτούς, στους 24 δόθηκε αγωγή με πινδολικό Mg σε δόση 600 mg ημερησίως ρένος για 3 μήνες, ενώ άλλοι 10 ασθενείς παρέμειναν μόνα στα υγιεινοδιαιτητικά μέτρα και παρακολουθήθηκαν για το αντίστοιχο χρονικό διάστημα (ομάδα ελέγχου). Οι κυριότεροι παράγοντες που εξετάστηκαν ήταν η ΑΠ με 24 ώρες καταγραφή της, τα ενδοκυττάρια ιόντα (K⁺, Na⁺, Ca⁺⁺, Mg⁺⁺), τα επίπεδα ινσουλίνης και γλυκόζης μετά από δοκιμασία ανοχής γλυκόζης (ΟΕΠ) οπού αργότερα υπολογίστηκε η ινσουλινοευαισθησία, το λιπιδαιμικό προφίλ, η νεφρική λειτουργία, οι ηλεκτρολύτες ορού και η αποβολή Mg στα ούρα 24ωρου. Αποτελέσματα: Συμπερασματικά η μελέτη αυτή παρουσίασε αρκετά νέα και σημαντικά στοιχεία γα την επίδραση του Mg στην ομάδα ασθενών με ΑΥ. Παρατηρήθηκε α) σημαντική βελτίωση της ινσουλινοευαισθησίας, β) σημαντική πτώση των επιπέδων της 24ωρης ΣΑΠ και ΔΑΠ, γ) σημαντική μείωση της ολικής χοληστερόλης και των τριγλυκεριδίων και αύξηση της HDL, δ) σημαντική αύξηση του icMg και icK και ελάττωση icCa και icNa, ε) ελάττωση AUC σακχάρων και AUC ινσουλίνης

Effect of hospitalization on 24-h ambulatory blood pressure of hypertensive patients

The aim of this study is to assess the effect of hospital admission on 24-h ambulatory blood pressure (ABP) in hypertensive subjects. Treated or untreated hypertensive adults with open-angle glaucoma underwent inpatient and outpatient 24-h ABP monitoring in a random order 4 weeks apart. Awake ambulatory hours, awake in-bed hours and sleep hours were reported by participants. The nighttime-to-daytime ABP dip (%) and the sleeping-to-awake dip (ambulatory and in-bed) were determined using the two ABP recordings. A total of 40 subjects were analyzed (mean age 65.7±8.4 (s.d.) years, n=19 men). Daytime systolic BP (SBP) was lower in the hospital than in the outpatient setting (mean difference 4.3±10.4 mm Hg, P=0.01), as was the awake ambulatory SBP (mean difference 5.0±11.1 mm Hg, P=0.008). No differences were detected in 24 h, nighttime or sleeping SBP or in any of the respective diastolic outpatient vs. inpatient ABP measurements. The nighttime SBP dip (vs. daytime) was larger in the outpatient setting (8.9±7.5% and 5.2±4.7%, respectively; P=0.003). Sleeping SBP dip (vs. awake ambulatory and awake in-bed) was also larger in the outpatient setting (11.1±7.3 and 7.8±5.9%, respectively; P0.02) with no difference in diastolic ABP. These data suggest that inpatient 24-h ABP monitoring does not reflect the usual BP level during routine daily life, nor does it represent the usual diurnal pattern of an individual. Relying on the 24-h ABP monitoring performed in the hospital environment may lead to an underestimation of ABP and an overdiagnosis of non-dippers. Therefore, 24-h ABP monitoring for decision making regarding diagnosis and treatment of hypertension should be performed only in the routine daily conditions of each individual. © 2010 The Japanese Society of Hypertension All rights reserved

Wave reflections and systemic vascular resistance are stronger determinants of pulse pressure amplification than aortic stiffness in drug-naïve hypertensives

Background: Aortic-to-brachial pulse pressure (PP) amplification is a novel biomarker that prognosticates the cardiovascular risk above and beyond central aortic and brachial blood pressure. This phenomenon is modulated by left ventricular contractility and chronotrophy, large-artery stiffness and reflecting properties of microcirculation. However, the relative importance of these parameters as hemodynamic determinant of PP amplification remains elusive. Methods: A total of 88 consecutive drug-naïve hypertensives underwent a non-invasive assessment of central and peripheral hemodynamics via impedance cardiography and pulse wave analysis. Participants were classified into tertiles according to the magnitude of PP amplification. Hemodynamic determinants of low PP amplification were explored in univariate and multivariate regression analysis. Results: Compared with the high tertile, patients within the low PP amplification tertile were older and more commonly female and had lower height, weight and heart rate. Augmentation index (AIx) and systemic vascular resistance index (SVRI) were higher among patients within the low PP amplification tertile, whereas aortic pulse wave velocity (PWV) did not differ among groups. In multivariate analysis, higher AIx (OR: 1.27; 95% CI: 1.09–1.48) and higher SVRI were independently associated with higher odds for low PP amplification, whereas higher heart rate was the only parameter related to lower odds for low PP amplification (OR: 0.84; 95% CI: 0.71–0.99). Conclusion: This study shows that among newly-diagnosed drug-naïve hypertensives, elevated wave reflections and systemic vascular resistance are stronger determinants of PP amplification than aortic stiffness. © 2019, © 2019 Taylor & Francis

Wave reflections and systemic vascular resistance are stronger determinants of pulse pressure amplification than aortic stiffness in drug-naïve hypertensives

Background: Aortic-to-brachial pulse pressure (PP) amplification is a novel biomarker that prognosticates the cardiovascular risk above and beyond central aortic and brachial blood pressure. This phenomenon is modulated by left ventricular contractility and chronotrophy, large-artery stiffness and reflecting properties of microcirculation. However, the relative importance of these parameters as hemodynamic determinant of PP amplification remains elusive. Methods: A total of 88 consecutive drug-naïve hypertensives underwent a non-invasive assessment of central and peripheral hemodynamics via impedance cardiography and pulse wave analysis. Participants were classified into tertiles according to the magnitude of PP amplification. Hemodynamic determinants of low PP amplification were explored in univariate and multivariate regression analysis. Results: Compared with the high tertile, patients within the low PP amplification tertile were older and more commonly female and had lower height, weight and heart rate. Augmentation index (AIx) and systemic vascular resistance index (SVRI) were higher among patients within the low PP amplification tertile, whereas aortic pulse wave velocity (PWV) did not differ among groups. In multivariate analysis, higher AIx (OR: 1.27; 95% CI: 1.09–1.48) and higher SVRI were independently associated with higher odds for low PP amplification, whereas higher heart rate was the only parameter related to lower odds for low PP amplification (OR: 0.84; 95% CI: 0.71–0.99). Conclusion: This study shows that among newly-diagnosed drug-naïve hypertensives, elevated wave reflections and systemic vascular resistance are stronger determinants of PP amplification than aortic stiffness

A Mediterranean Diet to Improve Cardiovascular and Cognitive Health: Protocol for a Randomised Controlled Intervention Study

The Mediterranean diet has demonstrated efficacy for improving cardiovascular and cognitive health. However, a traditional Mediterranean diet delivers fewer serves of dairy and less dietary calcium than is currently recommended in Australia, which may limit long-term sustainability. The present study aims to evaluate whether a Mediterranean diet with adequate dairy and calcium can improve cardiovascular and cognitive function in an at-risk population, and thereby reduce risk of cardiovascular disease (CVD) and cognitive decline. A randomised, controlled, parallel, crossover design trial will compare a Mediterranean diet supplemented with dairy foods against a low-fat control diet. Forty participants with systolic blood pressure above 120 mmHg and at least two other risk factors of CVD will undertake each dietary intervention for eight weeks, with an eight-week washout period between interventions. Systolic blood pressure will be the primary measure of interest. Secondary outcomes will include measures of cardiometabolic health, dietary compliance, cognitive function, assessed using the Cambridge Neuropsychological Test Automated Battery (CANTAB), psychological well-being and dementia risk. This research will provide empirical evidence as to whether the Mediterranean diet can be modified to provide recommended dairy and calcium intakes while continuing to deliver positive effects for cardiovascular and cognitive health. The findings will hold relevance for the field of preventative healthcare and may contribute to revisions of national dietary guidelines

Determination of trace metals, moisture, pH and assessment of potential toxicity of selected smokeless tobacco products

The characterization and classification of smokeless tobacco products has been a continuously evolving process. This is based on a number of different parameters like nicotine content, moisture content, amount of heavy metals, pH, and in vitro cytotoxicity assays. Their contexts often vary between countries, research institutions, and legal requirements. The categorisation of these products is quite challenging due to the diffused sample sizes, diverse array of branded products on offer, and the absence of a centralized manufacturing facility. This study aims at a systematic classification of 10 smokeless tobacco product samples from the retail market based on their potential toxicity upon long-term use. The estimation of potential toxicity follows a well-established method that employs the concentration of toxic metals in the different samples. The potential toxicity as well as heavy metal concentrations of the smokeless tobacco products analysed was found to be much higher than acceptable limits. For instance, the levels of lead, cadmium, copper and zinc of 2.5, 1, 4 and 23 ppm, respectively, are well above their recommended limits. The results from the study indicate that chronic use of smokeless tobacco products is a significant health risk, especially in the vulnerable population. Further studies of this nature will help establish a toxicological fingerprint on the diverse class of products that floods the market now